Clinician Decision Making in Managing Primary Aldosteronism: A Qualitative Study

Area of Science:

• Endocrinology
• Hypertension Management
• Qualitative Health Research

Background:

• Primary aldosteronism (PA) is a prevalent condition often underdiagnosed in hypertensive patients.
• PA is linked to adverse cardiovascular and kidney outcomes despite effective treatments.
• Understanding clinician perspectives is crucial for improving PA diagnosis and management.

Purpose of the Study:

• To identify key factors influencing the screening, diagnosis, and treatment of PA from the clinician's viewpoint.
• To explore barriers and facilitators affecting PA detection and management decisions.
• To inform the development of interventions targeting clinicians to enhance PA care.

Main Methods:

• Exploratory qualitative study involving 38 Australian clinicians (cardiologists, endocrinologists, GPs, nephrologists).
• In-depth semistructured interviews conducted and analyzed using deductive content analysis (CFIR) and inductive thematic analysis.
• Purposive sampling ensured diversity in clinician experience and practice setting.

Main Results:

• Four themes emerged: clinician factors, diagnostic complexity/burden, service/information accessibility, and system-level influences.
• Barriers include narrow patient cohort consideration, perceived diagnostic complexity, limited service access, and fragmented care.
• Facilitators include access to specialized units and multidisciplinary decision-making.

Conclusions:

• Clinician knowledge, perceptions, and the complexity of PA diagnosis significantly impact screening and treatment.
• Improving accessibility to diagnostic services and fostering collaborative care are key to enhancing PA detection and management.
• Findings provide guidance for clinician-targeted interventions to improve PA diagnosis and outcomes.